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Positive predictive factors and subgroup analysis of clinically relevant improvement after anterior cervical decompression and fusion for cervical disc disease: a 10-to 13-year follow-up of a prospective randomized study Clinical article
Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Activity and Health.
Sahlgrens University Hospital, Sweden .
Ryhov Hospital, Sweden .
Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.ORCID iD: 0000-0002-6075-4432
2013 (English)In: Journal of Eurosurgery : Spine, ISSN 1547-5654, E-ISSN 1547-5646, Vol. 19, no 4, 403-411 p.Article in journal (Refereed) Published
Abstract [en]

Object. The main purpose of this 10- to 13-year follow-up of a prospective randomized study was to identify preoperative factors that predicted good long-term outcome after anterior cervical decompression and fusion (ACDF) with the Cloward procedure or the cervical intervertebral fusion cage. A second purpose was to investigate subgroup differences at the 10-year follow-up between patients with and without clinically relevant improvement (CRI) and between men and women. less thanbrgreater than less thanbrgreater thanMethods. To evaluate clinically meaningful outcomes, good outcome was defined as CRI in neck-related pain intensity (andgt;= 30-mm improvement on a visual analog scale), and CRI in neck-specific disability (andgt;= 20% improvement in the neck disability index [NUT]) from preoperative measurements to the 10-year follow-up. A total of 73 patients (77% of the original study sample) completed questionnaires at least 10 years after ACDF. less thanbrgreater than less thanbrgreater thanResults. High preoperative neck-related pain intensity and preoperative nonsmoking status were predictors of CRI in neck-related pain intensity, and male sex was a predictor of CRI in neck-specific disability; however, no additional predictive factors were identified for good outcome after ACDF. The surgical procedure, number of operated levels, and radiological factors such as healing status did not influence the prediction models. Individuals without CRI in neck-specific disability (75%) and pain intensity (43%) reported a worse outcome for several psychosocial outcome variables compared with those with CRI. At the 10-year follow-up, women reported significantly greater neck- and arm-related pain intensity than men, and women also reported more disability and worse psychosocial status. Women reported CRI on the NDI less frequently than men (p = 0.01). less thanbrgreater than less thanbrgreater thanConclusions. Preoperative predictive factors of good outcome 10-13 years after ACDF included initial high neck-related pain intensity, nonsmoking status at the time of surgery, and male sex. There were greater improvements in pain intensity than in neck-specific disability, and the latter showed a greater association with psychosocial factors. These results suggest the need for multimodal postoperative rehabilitation for patients who do not have a satisfactory outcome after ACDF.

Place, publisher, year, edition, pages
American Association of Neurological Surgeons , 2013. Vol. 19, no 4, 403-411 p.
Keyword [en]
cervical disc disease, radiculopathy, anterior cervical fusion, clinical relevant outcome, prognostic factors
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-100024DOI: 10.3171/2013.7.SPINE12843ISI: 000324964700002OAI: oai:DiVA.org:liu-100024DiVA: diva2:659446
Note

Funding Agencies|Swedish Research Council||Medical Research Council of Southeast Sweden (FORSS)||County Council of Ostergotland||

Available from: 2013-10-25 Created: 2013-10-25 Last updated: 2017-12-06
In thesis
1. Clinical and patient-reported outcomes after anterior cervical decompression and fusion surgery: A focus on functioning and daily life
Open this publication in new window or tab >>Clinical and patient-reported outcomes after anterior cervical decompression and fusion surgery: A focus on functioning and daily life
2015 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Anterior cervical decompression and fusion (ACDF), with or without an intervertebral cage to add support to the fused segment, is an established surgical treatment of cervical radiculopathy due to cervical disc disease. High recovery rates and pain reductions after surgery have been reported, with similar results with or without a cage. A few small studies have evaluated neck-related physical function and patient-reported disability with less promising results. No previous studies have evaluated clinical and patientreported measures of functioning or compared the Cloward Procedure with the Cervical Intervertebral Fusion Cage (CIFC) more than 10 year after surgery. No studies have explored the patients’ perspective on surgical outcome Knowledge on long-term functioning may provide a base for improved postoperative care and rehabilitation. Combining the perspectives of clinicians and patients may provide a better understanding of outcome after ACDF surgery than has previously been reported.

The overall aim of the thesis was to evaluate long-term functioning after anterior cervical decompression and fusion surgery due to cervical disc disease, and to provide new insights into patients’ experiences of daily life after surgery.

The more than 10-year patient-reported outcomes of pain, disability and psychosocial factors (n=77), as well as clinical outcomes of neck-related physical function (n=51) were evaluated and compared between the Cloward Procedure and the CIFC. Preoperative and surgery-related factors of importance for a good outcome in neck-related pain and disability at 10-year follow-up were also identified. Fourteen women were interviewed at 1.5 to 3 years after ACDF to explore their experiences of daily life.

There were no differences between the surgical techniques in long-term neck-related pain or patient-reported disability. Secondary outcomes were, with a few exceptions, similar between groups. Neck-related pain decreased after surgery and remained improved from the 2-year to the 10-year follow-up. However, disability ratings remained improved only in the CIFC group. Predictors of a successful outcome in neck-related pain intensity were high preoperative neck-related pain intensity (Odds Ratio 1.06) and nonsmoking (Odds Ratio 3.03). Male gender was the only predictive factor of a successful outcome in neck-related disability (Odds Ratio 4.33). Moderate to severe pain and patient-reported disability were seen in half of the participants at the 10-year follow-up, and neck-related physical impairments were seen in between 18% (cervical flexion) and 82% (neck-muscle endurance) of participants. Daily life was experienced as recovered or improved by women after ACDF surgery. However they were at the same time affected and limited by remaining symptoms. Behaviors and activities were altered to adjust to the symptoms. Social support provided by family, social and occupational networks, and by healthcare professionals were experienced as important in a good daily life.

In conclusion: long-term pain, physical function and patient-reported disability were similar between the two ACDF techniques. High preoperative pain intensity, non-smoking and male gender predicted a good long-term outcome. Individuals after ACDF surgery experienced improvements in pain intensity and a good effect of surgery although they simultaneously reported residual or recurrent disability.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2015. 77 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1443
National Category
Physiotherapy Nursing
Identifiers
urn:nbn:se:liu:diva-117347 (URN)10.3384/diss.diva-117347 (DOI)978-91-7519-134-8 (ISBN)
Public defence
2015-05-22, Berzeliussalen, Campus US, Linköping, 09:00 (Swedish)
Opponent
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Available from: 2015-04-23 Created: 2015-04-23 Last updated: 2015-05-06Bibliographically approved

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Hermansen, AnnaPeolsson, Anneli

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